Breast cancer

Breast cancer is a growth of cells that starts in the breast tissue. Breast cancer most often starts in the tubes, called ducts, that can carry breast milk to the nipple. It also can start in the milk-producing glands, which are called lobules.

After skin cancer, breast cancer is the most common cancer diagnosed in women in the United States. But breast cancer doesn't just happen in women. Everyone has breast tissue, so anyone can get breast cancer, including men.

Breast cancer survival rates have been increasing. And the number of people dying of breast cancer is steadily going down.

Advances in breast cancer screening are helping healthcare professionals find breast cancer when it's small and more likely to be treated successfully. Even when breast cancer can't be cured, many treatments exist to slow its growth and help you live longer. New discoveries in breast cancer research are helping healthcare professionals choose the most effective treatment plans.

Breast cancer also may be called a malignant tumor of the breast. Malignant means cancerous and tumor means a growth of cells. Not all tumors in the breast are cancers. Noncancerous breast tumors, also called benign breast tumors, include fibroadenomas and others. The difference between benign and malignant tumors is that malignant tumors can invade and destroy healthy body tissue. Benign tumors don't do this.

There are many types of breast cancer, and the same breast cancer may be described in several ways. The type of cancer you have may be named for the cells where the cancer started. It also may be named for the features found in the cancer cells, whether it has spread or other factors.

Types based on the cells where cancer starts

Cancers that can happen in the breast can be divided into types based on the cells where the cancer starts.

• Ductal carcinoma starts in cells in a breast duct. A breast duct is a small tube that can carry breast milk to the nipple. This type of breast cancer includes ductal carcinoma in situ (DCIS), which is a noninvasive form of breast cancer, and invasive ductal carcinoma.
• Lobular carcinoma starts in cells in a breast lobule. A breast lobule is a gland that can make breast milk. This type is called invasive lobular carcinoma.
• Lymphoma starts in the lymphatic system. The lymphatic system is made up of organs, glands, tubelike vessels and clusters of cells called lymph nodes. It's part of the body's germ-fighting immune system. The most common type that affects the breast is diffuse large B-cell lymphoma.
• Soft tissue sarcoma starts in soft tissue cells. The soft tissues connect, support and surround other body structures. Soft tissues include muscle, fat, blood vessels and nerves. The most common type of sarcoma that affects the breast is angiosarcoma.

Types based on features of the cancer cells

Ductal and lobular breast cancers are often broken down into subtypes based on the features of the cells. These subtypes are based on whether the cells have hormone receptors or make too much of a protein called HER2. A cancer is called positive when testing finds these features and negative when testing does not find them.

• Hormone receptor (HR) positive breast cancer has receptors for the hormones estrogen, progesterone or both. This type, which includes estrogen receptor positive breast cancer, is often treated with estrogen blocker therapy.
• HER2 positive breast cancer has high levels of the HER2 protein or extra copies of the HER2 gene. HER2 positive breast cancer is often treated with targeted therapy medicines.
• Triple-negative breast cancer doesn't have either kind of hormone receptor and does not make high levels of HER2. Triple-negative breast cancer may be treated with chemotherapy and immunotherapy.
• Triple-positive breast cancer has both kinds of hormone receptors and has high levels of HER2. Triple-positive breast cancer may be treated with estrogen blocker therapy and medicines that target HER2.

Other types

Other types of breast cancer may depend on who the cancer affects. Types also may depend on whether the cancer affects the breast skin or nipple and whether it spreads or comes back after treatment.

• Inflammatory breast cancer is a form of breast cancer that affects the breast skin. Inflammatory breast cancer causes skin changes that look like a rash.
• Male breast cancer happens in the breast tissue in men. Male breast cancer is rare.
• Metastatic breast cancer is cancer that has spread to other parts of the body. Metastatic breast cancer most often spreads to the brain, bones, liver and lungs.
• Paget's disease of the breast is a form of breast cancer that affects the nipple. Paget's disease of the breast is rare.
• Recurrent breast cancer is cancer that comes back after treatment. Recurrent breast cancer can come back in the breast area or in other parts of the body.

Breast cancer symptoms can include a breast lump, nipple changes, and changes in the skin or shape of the breast. Breast cancer may not cause symptoms at first. Symptoms can vary based on whether the cancer is at an early or advanced stage. Symptoms also may differ in men and in people with inflammatory breast cancer.

General breast cancer symptoms

Signs and symptoms of breast cancer may include:

• A breast lump or thickened area of skin that feels different from the surrounding tissue.
• A nipple that looks flattened or turns inward.
• Changes in the color of the breast skin. In people with white skin, the breast may look pink or red. In people with brown and black skin, the breast may look darker than other areas on the chest or it may look red, purple or brown.
• Change in the size, shape or appearance of a breast.
• Changes to the skin over the breast, such as dimpling or skin that looks like an orange peel.
• Peeling, scaling, crusting or flaking of the skin on the breast.

Breast cancer lumps may have certain features. But how a lump feels can't tell you for sure whether it's cancer. In general, breast lumps caused by breast cancer usually feel firm and have an irregular shape. Lumps that aren't cancer may be less firm. They often feel round. A breast cancer lump may not move when you press on it. A lump that isn't cancer may move. Breast cancer lumps typically don't cause breast pain.

Early breast cancer symptoms

Breast cancer may not cause symptoms at first. It often is found when a screening mammogram shows something concerning. When breast cancer does cause symptoms, a breast lump is one of the most common signs.

Advanced breast cancer symptoms

When breast cancer spreads, it's called metastatic breast cancer. Symptoms can include:

• Bone pain.
• Feeling very tired.
• Shortness of breath.
• Swollen lymph nodes.
• Weight loss without trying.

Breast cancer symptoms in men

Male breast cancer symptoms include:

• A lump or thickening of the skin on the chest, most often near the nipple.
• Changes to the skin covering the chest, such as dimpling, puckering, scaling or changes in the color of the skin.
• Changes to the nipple, such as changes in the skin color or scaling, or a nipple that begins to turn inward.
• Discharge or bleeding from the nipple.
• Swollen lymph nodes in the armpit.

Inflammatory breast cancer symptoms

Inflammatory breast cancer sometimes looks like a breast rash. Symptoms may include:

• A change in the appearance of one breast that develops over several weeks.
• Thickness, heaviness or swelling of one breast.
• Changes in skin color, such as a red, purple, pink or bruised appearance.
• Unusual warmth of the affected breast.
• Dimpling or ridges on the skin of the affected breast, similar to an orange peel.

When to see a doctor

If you find a lump or other change in your breast, make an appointment with a doctor or other healthcare professional. Don't wait for your next mammogram. Report any changes in your breasts even if a recent mammogram showed there was no breast cancer.

The exact cause of most breast cancers isn't known. Researchers have found things that increase the risk of breast cancer. These include hormones, lifestyle choices and things in the environment. But it's not clear why some people who don't have any risk factors get cancer, yet others with risk factors never do. It's likely that breast cancer happens through a complex interaction of your genetic makeup and your environment.

Breast cancer starts when something changes the DNA inside cells in the breast tissue. A cell's DNA holds the instructions that tell a cell what to do. In healthy cells, the DNA gives instructions to multiply at a set rate. The instructions also tell the cells to die off at a set time. In cancer cells, the changes to the DNA alter the instructions for multiplying and dying. The result is that the cancer cells multiply faster than healthy cells. And they can keep living when healthy cells would die. This causes too many cells in the area.

The cancer cells might form a growth, called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer. Breast cancer most often spreads to the bones, brain, liver and lungs.

The main risk factors for breast cancer are getting older and being female. Other risk factors may be related to your personal medical history, your reproductive history and exposure to hormones.

Risk factors related to your personal medical history and your family's medical history include:

• A family history of breast cancer. If a parent, sibling or child had breast cancer, your risk is increased. The risk is higher if your family has a history of getting breast cancer at a young age. The risk also is higher if you have multiple family members with breast cancer. Still, most people diagnosed with breast cancer don't have a family history of the disease.
• A personal history of breast cancer. If you've had cancer in one breast, you have an increased risk of getting cancer in the other breast.
• A personal history of breast conditions. Certain breast conditions are markers for a higher risk of breast cancer. These conditions include lobular carcinoma in situ (LCIS) and atypical hyperplasia of the breast. If you've had a breast biopsy that found one of these conditions, you have an increased risk of breast cancer.
• Increasing age. The risk of breast cancer goes up as you get older.
• Inherited DNA changes that increase cancer risk. Certain DNA changes that increase the risk of breast cancer can be passed from parents to children. The most well-known changes are called BRCA1 and BRCA2. These DNA changes can greatly increase your risk of breast cancer and other cancers, but not everyone with these DNA changes gets cancer.
• Radiation exposure. Radiation treatments to the chest as a child or young adult raise the risk of breast cancer.

Risk factors related to reproductive history and hormone exposure include:

• Beginning your period at a younger age. Beginning your period before age 12 increases the risk of breast cancer.
• Beginning menopause at an older age. Beginning menopause after age 55 increases the risk of breast cancer.
• Being female. Women are much more likely than men are to get breast cancer. But anyone can get breast cancer, including men.
• Having your first child at an older age. Giving birth to your first child after age 35 may increase the risk of breast cancer.
• Having never been pregnant. Having been pregnant one or more times lowers the risk of breast cancer. Never having been pregnant increases the risk.
• Menopausal hormone therapy. Taking certain hormone therapy medicines to manage the symptoms of menopause may increase the risk of breast cancer. The risk is linked to hormone therapy medicines that combine estrogen and progesterone.

Other risk factors include:

• Dense breast tissue. Breast tissue is made up of fatty tissue and dense tissue. Fatty tissue is made of fat. Dense tissue is made of milk glands, milk ducts and fibrous tissue. If you have dense breasts, you have more dense tissue than fatty tissue in your breasts. Having dense breasts increases the risk of developing breast cancer and makes it harder to detect cancer on a mammogram. Talk with your healthcare team about other tests you might have in addition to mammograms to look for breast cancer.
• Alcohol use. Drinking alcohol increases the risk of breast cancer. There is no safe amount of alcohol when it comes to breast cancer. The more alcohol you drink, the greater your risk.
• Obesity. Obesity increases the risk of breast cancer.

There's no sure way to prevent breast cancer. But some choices may help reduce your risk. These include maintaining a healthy weight, exercising and limiting alcohol. Breastfeeding, if possible, also may help reduce risk. Limiting menopausal hormone therapy may help as well. People at high risk also may consider preventive medicines or risk-reducing surgery.

Screening tests and breast self-exams don't prevent breast cancer. But they can help find breast cancer early, when treatment is more likely to be successful.

Consider breastfeeding

Breastfeeding may lower the risk of breast cancer. If you want to and are able, consider breastfeeding if you have a baby. The longer you breastfeed, the greater the protective effect.

Limit menopausal hormone therapy

Hormone therapy that uses a combination of estrogen and progesterone may increase the risk of breast cancer. Talk with a healthcare professional about the benefits and risks of hormone therapy.

Make healthy choices in your everyday life

Certain habits that are good for your overall health also may help lower your risk of breast cancer.

• Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit how often you drink and keep the amount small. For overall health, drink one or fewer drinks a day. Do not drink every day. The less you drink, the better. For breast cancer prevention, there is no safe amount of alcohol. So if you're concerned about your breast cancer risk, you may choose to not drink alcohol.
• Exercise most days of the week. Aim for at least 30 minutes of exercise on most days of the week. If you haven't been active lately, ask a healthcare professional whether exercise is safe for you. Start slowly and add more exercise over time.
• Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you need to lose weight, ask a healthcare professional about healthy ways to lower your weight. In general, try to eat fewer calories every day and slowly increase how much you exercise.

Talk with a healthcare professional about your cancer risk

If you have a family history of breast cancer or think that you may have an increased risk of breast cancer, talk about it with your healthcare professional. You may consider meeting with a genetic counselor or other professional trained in genetics to learn more about your risk. You also may consider genetic testing.

If your risk is high, you may have options to help lower your risk or help find the cancer early. These options may include:

• Preventive medicines.
• Risk-reducing surgery. This may involve prophylactic mastectomy to remove the breasts or oophorectomy to remove the ovaries.
• More-frequent breast cancer screening that uses breast MRI or other types of imaging in addition to mammograms.

Take steps to find breast cancer early

Breast cancer can't always be prevented, but you can take steps to help find it early.

• Ask about breast cancer screening. Talk with a healthcare professional about when to begin breast cancer screening. Ask about the benefits and risks of screening. Together, you can decide what breast cancer screening tests are right for you. Most healthcare professionals recommend beginning screening in your 40s and having screening every year or two.
• Become familiar with your breasts. Do occasional breast self-exams so that you know what your breasts typically feel like. If there is a new change, a lump or something not typical in your breasts, report it to a healthcare professional right away. Self-exams may help you to better understand the look and feel of your breasts. This might make it more likely that you'll notice if something changes.

Breast cancer diagnosis often begins with an exam. Your healthcare professional also may ask about your symptoms and medical history. Imaging tests can look for changes in the breast tissue. To confirm whether there is cancer, a sample of tissue is removed from the breast for testing.

Sometimes breast cancer diagnosis starts when a screening mammogram finds something concerning. Most mammogram guidelines recommend that women start breast cancer screening in their 40s and repeat it every year or two. If you have a family history of breast cancer or other risk factors that raise your risk, you may think about starting sooner or having screening more often. Talk about your breast cancer screening options with your healthcare team.

Breast exam

During a breast exam, a healthcare professional looks at the breasts for anything that's not typical. This might include changes in the skin or to the nipple. Then the health professional feels the breasts for lumps. The health professional also feels along the collarbones and around the armpits for lumps.

Mammogram

A mammogram is an X-ray of the breast tissue. Mammograms are commonly used to screen for breast cancer. If a screening mammogram finds something concerning, you might have another mammogram to look at the area more closely. This more-detailed mammogram is called a diagnostic mammogram. It's often used to look closely at both breasts.

Breast ultrasound

Ultrasound uses sound waves to make pictures of structures inside the body. A breast ultrasound may give your healthcare team more information about a breast lump. For example, an ultrasound might show whether the lump is a solid mass or a fluid-filled cyst. The healthcare team uses this information to decide what tests you might need next.

Breast MRI

MRI machines use a magnetic field and radio waves to create pictures of the inside of the body. A breast MRI can make more-detailed pictures of the breast. Sometimes this method is used to look closely for any other areas of cancer in the affected breast. It also might be used to look for cancer in the other breast. Before a breast MRI, you usually receive an injection of contrast material. The contrast helps the tissue show up better in the images.

Breast biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. For a breast biopsy, a healthcare professional puts a needle through the skin and into the breast tissue. The health professional guides the needle using images created with X-rays, ultrasound or another type of imaging. Once the needle reaches the right place, the health professional uses the needle to draw out tissue from the breast. A marker may be placed in the spot where the tissue sample was removed. This small metal marker shows up on imaging tests. It helps your healthcare team mark the area of concern.

Lab testing

The tissue sample from a biopsy goes to a lab for testing. Tests can show whether the cells in the sample are cancerous. Other tests give more details about the cells. The testing is done by pathologists. Pathologists are doctors who look for disease in cells, fluids and tissue removed from the body.

Results are often given in a pathology report. The results may show:

• Cell type. The results show whether the cancer cells are ductal cells, lobular cells or other kinds of cells.
• Cell grade. The grade of the breast cancer cells is based on how the cells look under a microscope. The grade tells the healthcare team whether the cancer is likely to grow slowly or quickly.
• Hormone receptor status. Most breast cancer cells use the hormones estrogen and progesterone to help them grow. Cells that do this have receptors that help them catch the hormones circulating in the bloodstream. If testing finds receptors for one or both hormones, the cancer is hormone receptor (HR) positive. If testing doesn't find receptors, then the cancer is HR negative.
• HER2 status. Some breast cancer cells use a protein called human epidermal growth factor receptor 2 (HER2) to help them grow. Healthy breast cells make some HER2, but the cancer cells can make a lot more. If tests show the cancer cells have extra copies of the HER2 gene or increased levels of the HER2 protein, the cancer is HER2 positive. If testing doesn't find these, the cancer is HER2 negative.
• Ki-67 score. Ki-67 is a protein that marks how fast the cancer cells divide. This is called the proliferation rate. The Ki-67 score goes from 0% to 100%. A higher score suggests a higher rate of dividing cells and faster growth.

The healthcare team uses the results from lab tests to decide on the cancer's stage, understand the prognosis and make a treatment plan.

Staging tests

Once your healthcare team diagnoses your breast cancer, you may have other tests to figure out the extent of the cancer. This is called the cancer's stage. Your healthcare team uses your cancer's stage to understand your prognosis.

Tests and procedures used to stage breast cancer may include:

• Blood tests, such as a complete blood count and tests to show how well the kidneys and liver are working.
• Bone scan.
• CT scan.
• MRI.
• Positron emission tomography (PET) scan.

Not everyone needs all of these tests. Your healthcare team picks the right tests based on your specific situation.

A cancer's grade is a number that tells the healthcare team how different the cancer cells look from healthy cells. Breast cancer grades go from 1 to 3.

To decide on the grade, doctors in the lab, called pathologists, use a microscope to look at cancer cells from a biopsy. If the cancer cells look similar to healthy cells, then the cancer cells are low grade. Low-grade cancer grows slowly. If the cancer cells look very different from healthy cells, then the cancer cells are high grade. High-grade cancer grows quickly.

The grades of breast cancer include:

• Grade 1. Grade 1 is a low grade. The cancer cells look similar to healthy cells. Grade 1 breast cancer typically grows slowly and has a low risk of spreading. It's sometimes called well-differentiated cancer.
• Grade 2. Grade 2 is an intermediate grade. The cancer cells look a little different from healthy cells. Grade 2 breast cancer grows more quickly than grade 1 cancer. It also has a higher risk of spreading. Sometimes it's called moderately differentiated cancer.
• Grade 3. Grade 3 is a high grade. The cancer cells look very different from healthy cells. Grade 3 breast cancer is considered a fast-growing cancer. It has the highest risk of spreading. Sometimes it's called poorly differentiated cancer.

The grade helps the healthcare team understand the prognosis and make a treatment plan. High-grade cancers are more likely to spread, so they may need more-intense treatment. Grade 1 or 2 breast cancer cells are more likely to have hormone receptors. These cancers are likely to be treated with estrogen blocker therapy. Grade 3 cancers are more likely to respond to chemotherapy.

Breast cancer treatments include surgery, radiation therapy and medicines. Medicines used to treat breast cancer include estrogen blocker therapy, chemotherapy, targeted therapy and immunotherapy.

For early-stage breast cancers, treatment often starts with surgery to remove the cancer. Many people have other treatments after surgery, such as radiation and medicines. Some people receive medicines before surgery.

When breast cancer is found early, it often can be cured. A cure is less likely when the cancer spreads to other parts of the body.

If the cancer spreads, treatment usually starts with medicines. Medicines can slow the growth of the cancer and help you live longer. If the first treatment stops working, the care team may adjust the medicines or try new medicines. Newer treatments and personalized treatment approaches are helping many people live longer with advanced breast cancer.

Your treatment plan depends on your particular breast cancer. Your healthcare team considers the stage of the cancer, how quickly it's growing, whether the cancer cells are sensitive to hormones and whether the cells make extra HER2. Your care team also considers your overall health and what you prefer.

Here's how aspects of your cancer may affect your treatment options:

• Ductal versus lobular. Invasive lobular carcinomas are more likely to be hormone receptor (HR) positive and HER2 negative, so these cancers usually are treated with estrogen blocker therapy. Invasive ductal carcinomas vary more in their HR status and HER2 status.
• Low grade versus high grade. Low-grade cancers are likely to be HR positive. They are more likely to be treated with estrogen blocker therapy. High-grade cancers are more likely to be treated with chemotherapy.
• HR positive versus HR negative. The HR status tells the healthcare team whether estrogen blocker therapy might work against the cancer. HR positive cancers, including estrogen receptor positive breast cancers, are treated with estrogen blocker therapy. HR negative cancers usually are not.
• HER2 positive versus HER2 negative. HER2 positive cancers often are treated with anti-HER2 targeted therapy. HER2 negative cancers usually aren't. Some cancers have a low level of HER2 but not enough to be called positive. These cancers are called HER2 low. They are sometimes treated with medicines used for HER2 positive cancer.
• Triple-negative cancer. Triple-negative breast cancer is HR negative and HER2 negative. Estrogen blocker therapy and anti-HER2 therapy generally aren't used for this cancer. It's more likely to be treated with chemotherapy and immunotherapy medicines.

There are many options for breast cancer treatment. You don't have to make these decisions on your own. Your healthcare team can help explain your options and work with you to choose a treatment plan that fits your needs and goals. Consider seeking a second opinion from a breast specialist in a breast center or clinic. Some people also find it helpful to talk with others who have faced similar breast cancer treatment decisions.

Breast cancer surgery

Breast cancer surgery typically involves a procedure to remove the breast cancer and, sometimes, a procedure to remove some nearby lymph nodes. The main surgical procedures used to treat breast cancer include:

• Lumpectomy. A lumpectomy is surgery to remove the breast cancer and some of the healthy tissue around it. It allows you to maintain most of your breast. Other names for this surgery are breast-conserving surgery and wide local excision. Most people have radiation therapy after lumpectomy.
• Mastectomy. A mastectomy is surgery to remove all breast tissue from a breast. Total mastectomy, also called simple mastectomy, removes all of the breast, including the lobules, ducts, fatty tissue and some skin, including the nipple and areola. Other procedures include skin-sparing mastectomy, which leaves the skin, and nipple-sparing mastectomy, which leaves the areola, nipple and skin.
• Lymph node surgery. Lymph node surgery removes nearby lymph nodes to check them for cancer. When breast cancer spreads, it most often goes to the lymph nodes under the arm. A sentinel node biopsy removes some of those lymph nodes for testing. An axillary lymph node dissection removes most of the underarm lymph nodes.
• Double mastectomy. Some people who have cancer in one breast may choose to have their other breast removed, even if it doesn't have cancer. Removing both breasts during the same surgery is called a double mastectomy. It might be an option if you have a high risk of getting cancer in the other breast. The risk might be high if you have a strong family history of cancer or have DNA changes that increase the risk of cancer.

Complications of breast cancer surgery depend on the procedures you choose. All operations have a risk of pain and infection. Removing lymph nodes in the armpit carries a risk of arm swelling, called lymphedema.

You may choose to have breast reconstruction after mastectomy surgery. Breast reconstruction is surgery to restore shape to the breast. Options might include reconstruction with a breast implant or reconstruction using your own tissue. Consider asking your healthcare team for a referral to a plastic surgeon before your breast cancer surgery.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources.

Radiation therapy for breast cancer often uses external beam radiation. During this type of radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.

Radiation therapy is often used after breast cancer surgery. It can kill any cancer cells that might be left after surgery. The radiation lowers the risk of the cancer coming back.

Side effects of radiation therapy include feeling very tired and having a sunburnlike rash where the radiation is aimed. The breast may be painful or feel more firm.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Many chemotherapy medicines exist. Chemotherapy for breast cancer often involves a combination of chemotherapy medicines. Most are given through a vein. Some are available in pill form.

Chemotherapy for breast cancer is often used after surgery. It can kill any cancer cells that might remain and lower the risk of the cancer coming back.

Sometimes chemotherapy is given before breast cancer surgery. This may help shrink the cancer so that surgery is possible or so that you might consider a less invasive surgery. It also gives the care team a chance to see how well the medicines work.

When the cancer spreads to other parts of the body, chemotherapy may help control it.

Chemotherapy side effects depend on which medicines you receive. Common side effects include hair loss, nausea, feeling very tired and mouth sores.

Estrogen blocker therapy

Estrogen blocker therapy treats breast cancer that is sensitive to hormones. This means the cancer cells have proteins called receptors. The receptors bind to the hormones estrogen and progesterone. The cancer grows in response to these hormones. Healthcare professionals call these cancers hormone receptor positive. Most breast cancers are sensitive to hormones.

Estrogen blocker therapy also is called endocrine therapy and hormone therapy for breast cancer.

Estrogen blocker therapy treatments can include:

• Medicines that block or destroy hormone receptors. These medicines are called selective estrogen receptor modulators.
• Medicines that lower hormone production. These medicines are called aromatase inhibitors.
• Surgery or medicines to stop the ovaries from making hormones.

Estrogen blocker therapy often is used after surgery and other treatments. It can lower the risk that the cancer will come back.

If the cancer spreads to other parts of the body, estrogen blocker therapy can help control it.

Estrogen blocker therapy side effects depend on the treatment you receive. The side effects can include hot flashes and night sweats.

Targeted therapy

Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Some treatments target cancer cells that make extra HER2. Breast cancer that makes extra HER2 is called HER2 positive breast cancer. Other targeted therapy medicines attack other proteins in the body that help cancer cells grow. Your cancer cells may be tested to see whether these medicines might help you.

Targeted therapy medicines may be used before surgery to shrink the cancer and make it easier to remove. Some are used after surgery to lower the risk that the cancer will come back. Others are used only when the cancer has spread to other parts of the body.

Side effects of targeted therapy differ greatly by the medicine. In general, this treatment can cause diarrhea, mouth sores and nail changes. There also can be changes in how well the liver works.

Immunotherapy

Immunotherapy is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Immunotherapy might be an option for treating cancer that's triple negative. Triple-negative breast cancer means that the cancer cells don't have hormone receptors and don't make extra HER2. This treatment may be used before and after surgery.

Immunotherapy side effects include diarrhea, feeling very tired and rash.

Palliative care

Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A team of healthcare professionals gives palliative care. This team can include doctors, nurses and other specially trained health professionals. Their goal is to improve the quality of life for you and the people who care about you.

Palliative care specialists work with you, your family and your healthcare team to help you feel better. They provide added support while you have cancer treatment. You can have palliative care at the same time as treatment for cancer, such as surgery, chemotherapy or radiation therapy.

When palliative care is used with other appropriate treatments, people with cancer may feel better and live longer.

No alternative medicine treatments have been found to cure breast cancer. But complementary and alternative medicine therapies for cancer may help you cope with side effects of treatment.

Alternative medicine for fatigue

Many people with breast cancer have fatigue during and after treatment. This feeling of being very tired and worn down can continue for years. When combined with care from your healthcare team, complementary and alternative medicine therapies may help relieve fatigue.

Talk with your healthcare team about trying these options.

• Expressing your feelings. Find an activity that allows you to write about or discuss your emotions. Examples include writing in a journal, participating in a support group or talking to a counselor.
• Gentle exercise. If you get the OK to exercise from your healthcare team, choose a gentle activity that you enjoy. Add more exercise as you feel up to it. Consider walking, swimming and yoga.
• Managing stress. Take control of the stress in your daily life. Try stress-reduction techniques such as muscle relaxation, visualization, and spending time with friends and family.
• Other options. Acupuncture treatments and massage may help with fatigue. Get the OK from your healthcare team first to make sure these are safe for you.

Learning you have breast cancer can be unexpected, and it's natural to have questions about what comes next. You may be receiving a lot of information and facing decisions about surgery, radiation and medical treatments. It's common to have a range of feelings that may change from day to day, and it can take time to process everything. As you move forward, here are some ideas that might be helpful.

Learn enough to make decisions about your care

If you'd like to know more about your breast cancer, ask your healthcare team for the details of your cancer. Write down the type, stage and hormone receptor status. Ask for good sources of information where you can learn more about your treatment options.

Knowing more about your cancer and your options may help you feel more confident when making treatment decisions. Still, some people don't want to know the details of their cancer. If this is how you feel, let your care team know that too.

Find a good listener

Finding someone who is willing to listen to you talk about your hopes and fears can be helpful as you manage a cancer diagnosis. This could be a friend or family member. A counselor, medical social worker or clergy member also may offer helpful guidance and care.

Talk with others who have been diagnosed with breast cancer

You may find it helpful and encouraging to talk to others who have been diagnosed with breast cancer. Ask your healthcare team about local support groups, or contact the American Cancer Society or another cancer organization in your area to find resources. Find support online through Mayo Clinic Connect, a community where you can connect with others for support, practical information and answers to everyday questions.

Let friends and family help

Your friends, family or other people you trust can provide a crucial support network for you during your cancer treatment. As you begin telling people about your breast cancer diagnosis, you'll likely get many offers for help. Think ahead about things you may want help with. Examples include listening when you want to talk or helping you with preparing meals.

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you. If an exam or imaging test shows you might have breast cancer, your healthcare team likely will refer you to a specialist.

Specialists who care for people with breast cancer include:

• Breast medicine specialists.
• Breast surgeons.
• Genetic counselors.
• Oncologists. These doctors specialize in treating cancer.
• Plastic surgeons.
• Radiation oncologists. These doctors treat cancer with radiation.
• Radiologists. These doctors specialize in diagnostic tests, such as mammograms.

What you can do

Here are some things you can do to prepare.

• Write down any symptoms you're experiencing. Include symptoms even if they don't seem related to the reason you scheduled the appointment.
• Write down key personal information. Include any major stresses or recent life changes.
• Write down your family history of cancer. Note any family members who have had cancer. Note how each member is related to you, the type of cancer, the age at diagnosis and whether each person survived.
• Make a list of all medicines, vitamins or supplements that you're taking.
• Keep all records that relate to your cancer diagnosis and treatment. Organize them in a binder, folder or digitally. Take your records with you to your appointments.
• Take a family member or friend along if possible. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional.

Your time with your healthcare professional is limited. Prepare a list of questions so that you can make the most of your time together. List your questions from most important to least important in case time runs out.

Questions to ask about your diagnosis include:

• What type of breast cancer do I have?
• What is the stage of my cancer?
• Can you explain my pathology report to me? Can I have a copy for my records?
• Do I need any more tests?

Questions to ask about treatments include:

• What treatment options are available for me?
• What are the benefits from each treatment you recommend?
• What are the side effects of each treatment option?
• How will each treatment affect my daily life? Can I continue working?
• Is there one treatment you recommend over the others?
• What would you recommend to a friend or family member in my situation?
• How quickly do I need to make a decision about cancer treatment?
• What happens if I don't want cancer treatment?

Other questions to ask include:

• What will cancer treatment cost?
• Does my insurance plan cover the tests and treatment you're recommending?
• Should I seek a second opinion? Will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What websites or books do you recommend?
• Are there any clinical trials or newer treatments that I should consider?

In addition to the questions that you've prepared, don't hesitate to ask other questions you think of during your appointment.

What to expect from your doctor

Be prepared to answer some questions about your symptoms and your health, such as:

• When did your symptoms start?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Has a mammogram ever detected something concerning?
• Have you ever had a breast biopsy?

Staging is a way to describe the size of the cancer and whether it has spread. Your breast cancer's stage helps your healthcare team understand your prognosis. It also helps your team create a treatment plan that fits your cancer.

Breast cancer stages range from 0 to 4. A lower number means the cancer is less advanced and more likely to be cured. As the cancer grows and gets more advanced, the stages get higher. A stage 4 breast cancer means that the cancer has spread to other parts of the body.

Staging information

To stage the breast cancer, the healthcare team collects as much information about the cancer as possible. The information comes from the exams and imaging tests you've had, as well as the biopsy report from the pathologist.

Information used in staging includes:

• The size of the cancer in the breast.
• Whether cancer cells have spread to the lymph nodes or other parts of the body.
• The cancer's grade.
• The cancer's hormone receptor status.
• The cancer's HER2 status.
• The presence of certain genes that might impact treatment options.
• Other pieces of information that may become available after the cancer is removed during surgery.

Types of staging

The process of breast cancer staging can take place at different times after diagnosis and around treatment. Your stage may change as your care team gets more information about your cancer.

Healthcare professionals use different types of stages at different times.

• Anatomic staging happens after a breast biopsy confirms cancer. It tells your care team about the size of the cancer and whether it has spread. It does not take cancer grade, hormone receptor status or HER2 status into account.
• Clinical prognostic staging happens after all tests on your biopsy sample are complete and your care team knows your cancer grade, hormone receptor status and HER2 status. The prognostic staging process tells your care team more about how well medical treatment works against the cancer. It helps the team choose the first treatment.
• Pathological prognostic staging is used after surgery once the cancer is removed. This kind of staging looks at factors such as the size of the cancer removed during surgery and the number of lymph nodes removed that contain cancer.
• Postneoadjuvant therapy prognostic staging is used when you receive medicine as your first treatment for breast cancer. This staging process considers the status of the cancer after the medicine is given. It can help your care team decide what to do next.

Because there are several types of stages that consider different factors, the stages of breast cancer can be confusing and complicated. Ask your healthcare team to explain your stage and what it means for your treatment.

Anatomic stages

Anatomic staging is the simplest form of breast cancer staging. To decide on the anatomic stage, the healthcare team uses the size of the cancer and whether it has spread. Using this type of staging, the stages go from 0 to 4.

• Stage 0. Cancer cells have not grown beyond the ducts. This cancer does not spread. Ductal carcinoma in situ is a stage 0 noninvasive cancer.
• Stage 1. The cancer in the breast is less than 1 inch (2 centimeters) in diameter. Cancer cells have spread beyond the ducts into the breast tissue. There is little or no evidence of cancer in the lymph nodes. Cancer has not spread elsewhere in the body.
• Stage 2. The cancer in the breast is less than 2 inches (5 centimeters) in diameter and has spread to some underarm lymph nodes. Or the cancer is larger than 2 centimeters in diameter and has not spread to the underarm lymph nodes.
• Stage 3. The cancer in the breast is any size and has spread to many underarm lymph nodes. Or the cancer is larger than 2 inches (5 centimeters) in diameter and has spread to some underarm lymph nodes. This stage also includes cancers that spread to the skin, the chest beyond the muscle, or the lymph nodes inside the chest wall. Inflammatory breast cancer is considered a stage 3 cancer.
• Stage 4. The cancer in the breast is any size and cancer cells have spread to sites away from the breast and nearby lymph nodes. These sites may include the brain, bones, lungs or liver.

The anatomic stage may be the first stage your healthcare team talks about after your diagnosis. The stage may change as your team gets more information about your cancer, such as the hormone receptor status.

The survival rates for breast cancer are quite good, especially when the cancer is caught early. Early-stage breast cancer has a good prognosis. Many people are cured. Even when a cure isn't possible, treatments often can slow the cancer's growth and extend your life.

People diagnosed with cancer often want to know the survival rates. Some people find these numbers helpful because they offer a general sense of what to expect and help put the diagnosis in perspective. Others don't find the survival rates helpful. The statistics may feel confusing, discouraging or overwhelming.

Survival statistics can provide general information about the seriousness of the situation, but they can't predict what will happen in any one person. These statistics include thousands of people with breast cancer, including people of different ages, with different health conditions and with different treatment histories.

Keep in mind that your healthcare team uses much more detailed information when talking with you about your individual prognosis and treatment options.

Survival statistics

The U.S. National Cancer Institute (NCI) tracks cancer survival rates in the United States. NCI breaks down the rates by how far the cancer has spread, rather than by stage.

• Localized cancer, which means the cancer is only in the breast, has a five-year relative survival rate of 100%.
• Regional cancer, which means the cancer has spread to nearby lymph nodes, has a five-year relative survival rate of 88%.
• Distant cancer, which means the cancer has spread to other parts of the body, has a five-year relative survival rate of 34%.

These are the survival rates for breast cancer in general. Survival rates vary depending on whether the cancer cells have hormone receptors or make extra HER2. Your own chances for survival depend greatly on the details of your cancer.

What affects prognosis

Cancer prognosis describes how likely it is that a cancer can be treated successfully or cured. Healthcare professionals estimate prognosis using information about the cancer and your overall health. To better understand your personal prognosis, talk with your healthcare team. Your team can explain the factors that affect your situation.

Things that can affect the prognosis for breast cancer include:

• Age at diagnosis. Breast cancer that happens in younger people, such as those 35 and younger, tends to grow more quickly. Breast cancer diagnosed at a later age tends to have a better prognosis.
• Cancer grade. Grades 1 and 2 cancers tend to grow more slowly and have a better prognosis than grade 3 cancers.
• HER2 status. Cancer cells that make extra HER2 tend to grow faster. But there are many treatments that target HER2. Because treatment is so effective, having a HER2 positive breast cancer gives a better prognosis.
• Hormone receptor status. Cancer cells that don't have receptors for the hormones estrogen and progesterone have fewer treatment options because these cancers don't respond to estrogen blocker therapy. If the cancer is hormone receptor positive, the prognosis is better. Researchers are studying new treatment options for hormone receptor negative cancers.
• The size of the cancer in the breast. A small cancer may be easier to remove completely and have a lower risk of spreading, so it has a better prognosis.
• Whether the lymph nodes contain cancer. Cancer that spreads to the lymph nodes has a higher risk of spreading to other parts of the body. If the cancer hasn't spread to the lymph nodes, the prognosis is better.

What you can do

After breast cancer treatment, healthcare professionals generally recommend making healthy choices that are good for anyone who wants improved health: Eat a balanced diet, exercise, maintain a weight that's healthy for you and limit the amount of alcohol you drink. For people with breast cancer, these healthy choices also might lower the risk of recurrent breast cancer.

Try to:

• Avoid alcohol. Research links drinking alcohol to a higher risk of breast cancer, but it's not clear whether alcohol raises the risk of the cancer coming back. If you choose to drink alcohol, limit how often you drink and keep the amount small. For overall health, drink one or fewer drinks a day. Do not drink every day. The less you drink, the better.
• Follow a healthy diet. Choose a diet that's rich in fruits, vegetables and whole grains. Limit how much red meat, processed meat and sugar you eat.
• Stay active. Aim to exercise most days of the week. If you don't exercise regularly, ask your healthcare professional if it's safe for you to start exercising. Start with short sessions of an activity you enjoy. Build up the amount of exercise over time.
• Strive for a healthy weight. Ask your healthcare professional what weight is healthy for you. If your weight is healthy, work to maintain it. If you need to lose weight, aim to do so slowly. Start by making healthy choices, such as eating fewer calories, moving more and sitting less.

Talk with your healthcare team about other things you can do to lower your risk of recurrence. Also follow your care team's advice on follow-up exams and tests after you finish cancer treatment.